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Advice needed

  1. Unhappy Advice needed
    Medical Coding Books
    I have just been terminated for refusal to,what I strongly believe is, double billing insurance companies. Is there anyone out there who has had any experience with this?

  2. #2
    North Carolina

    How awful ...yet this very well could be a blessing in disguise. Can you provide an example of your double billing scenario?

  3. #3
    Not a lot you can do when it is commercial insurance. You can notify their fraud department but that won't get your job back.

    If it involves government insurance (Medicare, Medicaid, Tricare, VA) then you can file a qui tam lawsuit on behalf of the government, you would be what is commonly referred to as a whistleblower. You can also file a retaliation law suit. This could get you double back pay and your job back if you win. Neither are quick fixes or sure things though.

    Good luck,

    Laura, CPC, CPMA, CEMC

  4. Default
    Thanks so much for your replies. The situation is: I was working for a billing company that bills out for an OB/GYN clinic. I was given a email with a list of about 30 patients that had transferred out, moved or had miscarriages. Usually I was able to split the antepartum care myself. I would go through the patients appointments and bill out the appropriate codes according to how many visits were left that had not already been submitted and paid for. This email however stated exactly which code to use and what dates of service and these included all of the previously paid visits. I attempted to talk to my manager about it because I felt it was double billing. I was told (in the hallway no-less) that its my job to enter the charges in that the clinic sends it over I bill it. These visits would be considered white bagged, which means there is no corresponding bill in the EMR side, no fee ticket, nothing. The charges would have went in under my name and mine alone. I again said I couldn't, that I believed it could be fraudulent. I was given 3 days no pay. When I went back to work I was given a letter of warning that had nothing to do with this issue. I requested that her letter state my refusal to enter in claims that according to the info I could find was double billing. She refused. Needless to say things went down hill from there. By the way this same business sent me to the AAPC to become a coder. As an member even if I'm not certified yet I still am required to follow the code of ethics, right? I have been billing/coding for them for last 14 months. I'm just having a hard time wrapping my head around this. Was I wrong?

  5. #5
    New Haven, CT
    Serious stuff there. I know I told my cousin, (who is a new Special Agent in the FBI,) that I wasn't going to wear orange for anyone. (He specializes in health care fraud.)

    I don't know if you'd want to stick out your neck and tell the FBI about this. That's what I'd think about. I have a feeling they'd let you be anonymous, but this is a sticky situation.

    Good luck!

  6. Default
    Thanks for your reply! I have been having anxiety attacks and questioning my self all day. I really don't know where to turn.

  7. #7
    Charleston, South Carolina
    I am sorry also you lost your job. Having known of a similar fraud situation in the past, and knowing the person who spoke with the FBI, they will try to keep your name private, but if it goes to court, you will become known I believe. This is my understanding. I also spoke with an FBI agent who specializes in HC fraud, she came to a chapter meeting, and she told me the same thing. I understand that to a point, but if you report them and follow the process thru, then your name becomes known. You would think most practices would appreciate your position, but there is the chance they will not see it in a good light. I certainly am not an expert, so you may want to check with a HC attorney who specializes in this area.

    Good luck to you, I really wish you the best. And good for you for standing up for ethics!!!
    Last edited by mmorningstarcpc; 06-23-2010 at 08:33 AM.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

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